UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: CYSTOSCOPY WITH BLADDER BIOPSY
Effective Date: January, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed November 2007 May 2009 March 2012
PURPOSE: To provide guidelines for the preparation and follow-up of patient undergoing a cystoscopy with bladder
biopsy at UWMF Clinics.
DEFINITION: A cystoscopy with bladder biopsy is performed to diagnose lesions or growths in the bladder, including
POLICY: The clinical staff will utilize the following guidelines to prepare a UWMF patient for a cystoscopy with
SUPPLIES: Provider’s order, Patient’s record, Flexible or rigid bugby
Use supply list from cystoscopy male or female
For rigid will use 21 Fr obturator and sheath
Rigid or flexible biopsy forcep (for flexible will need adaptor), Cautery machine and cautery cord,
Formalin container, biohazard specimen bag, patient’s lab slips
Consent “Cystoscopy with Bladder Biopsy”
1. Verify provider order.
2. Review and follow procedure for male or female cystoscopy.
3. Wash hands, gather equipment and set up as described.
4. Place grounding patch on patient’s leg, turn machine on and place foot pedal where physician will stand.
5. Attach cautery cord to cautery machine.
6. Place forcep and bugby on tray with cystoscope using sterile technique.
7. Attach bugby to cautery cord and drape over patient’s leg.
1. Turn off lights once provider has inserted scope.
2. Wash hands and put on sterile gloves.
3. Ensure patient is comfortable and assist physician (as needed).
4. Put tissue samples in formalin container. Label containers with at least two patient identifiers (full name, DOB,
MRN). Enter order into computer per provider preference. Send specimens to lab.
1. Assist patient to sitting position, offer bathroom, assist with dressing (if needed).
2. Clean scopes, forceps and bugby in Metrizyme solution.
3. Soak scopes and bugby in Metricide for 20 minutes.
4. Rinse scopes and bugby in sterile water basin and wrap in sterile towels.
5. Place forceps in autoclave pouch for sterilization.
6. Clean tray, counters and table with Dispatch.
7. Empty and clean drain (if used).
8. Label specimen and lab slips properly and bring specimen to lab.
9. If ordered, administer prescribed antibiotic prophylaxis. This varies with MD.
10. Discharge instructions as per cystoscopy protocol
May experience frequency, dysuria or hematuria.
11. Documentation (in Progress Notes section of HealthLink) in the patient’s record:
the procedure performed, date & time completed
name and amount of any medications given (using SmartPhrase: .medinclinic)
how patient tolerated procedure
follow-up appointment (if any)
WRITTEN BY: Deb Brausen, R.N., Manager, Department of Urology
Tracy Ancheta R.N., Department of Urology
Leslie Calkins, R.N., Department of Urology
Gail Jahnke, R.N., N.P., Department of Urology
REVIEWED BY: Donnette Kelly, R.N., Department of Urology, 2012
Carol Decker, RN, MSN, Clinical Staff Educator, 2012
Department of Surgery, Urology Date
Medical Director Date